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Predictors of timing of adjuvant chemotherapy in older women with hormone receptor–negative, stages II–III breast cancer

Breast Cancer Research and Treatment volume 131, pages 207–216 (2012)Cite this article

Abstract

Adherence to consensus guidelines for cancer care may vary widely across health care settings and contribute to differences in cancer outcomes. For some women with breast cancer, omission of adjuvant chemotherapy or delays in its initiation may contribute to differences in cancer recurrence and mortality. We studied adjuvant chemotherapy use among women with stage II or stage III, hormone receptor–negative breast cancer to understand health system and socio-demographic correlates of underuse and delayed adjuvant chemotherapy. We used Surveillance Epidemiology and End Results (SEER)-Medicare linked data to examine the patterns of care for 6,678 women aged 65 and older diagnosed with stage II or stage III hormone receptor–negative breast cancer in 1994–2002, with claims data through 2007. Age-stratified logistic regression was employed to examine the potential role of socio-demographic and structural/organizational health services characteristics in explaining differences in adjuvant chemotherapy initiation. Overall utilization of guideline-recommended adjuvant chemotherapy peaked at 43% in this population. Increasing age, higher co-morbidity burden, and low-income status were associated with lower odds of chemotherapy initiation within 4 months, whereas having positive lymph nodes, more advanced disease, and being married were associated with higher odds (P < 0.05). Health system–related structural/organizational characteristics and race/ethnicity offered little explanatory insight. Timely initiation of guideline-recommended adjuvant chemotherapy was low, with significant variation by age, income, and co-morbidity status. Based on these findings, future studies should seek to explore the more nuanced reasons why older women do not receive chemotherapy and why delays in care occur.

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Acknowledgments

Funding was provided by Dr. Wheeler’s National Research Service Award (NRSA) Predoctoral Traineeship from the Agency for Healthcare Research and Quality (AHRQ) sponsored by the Cecil G. Sheps Center for Health Services Research, UNC at Chapel Hill, Grant No. 5-T-32 HS000032-20, and a pilot grant, Grant No. 2KR50906 (PI: Wheeler) from the North Carolina Translational and Clinical Sciences (NC TraCS) Institute, Clinical and Translational Science Award (CTSA) Number UL1RR025747 from the National Center for Research Resources, National Institutes of Health.

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Affiliations

  1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB 7411, Chapel Hill, NC, 27599-7411, USA

    Stephanie B. Wheeler, William R. Carpenter, Morris Weinberger & Andrea K. Biddle

  2. Department of Medicine, Division of Medical Oncology, Duke University, Durham, NC, USA

    Jeffrey Peppercorn

  3. Public Health Leadership Program, University of North Carolina, Chapel Hill, NC, USA

    Anna P. Schenck

  4. Department of Veterans Affairs, Center of Excellence in Health Services Research in Primary Care, Durham, NC, USA

    Morris Weinberger

Authors
  1. Stephanie B. Wheeler
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  2. William R. Carpenter
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  3. Jeffrey Peppercorn
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  4. Anna P. Schenck
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  5. Morris Weinberger
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  6. Andrea K. Biddle
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Correspondence to Stephanie B. Wheeler.

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Wheeler, S.B., Carpenter, W.R., Peppercorn, J. et al. Predictors of timing of adjuvant chemotherapy in older women with hormone receptor–negative, stages II–III breast cancer. Breast Cancer Res Treat 131, 207–216 (2012). https://doi.org/10.1007/s10549-011-1717-6

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  • DOI: https://doi.org/10.1007/s10549-011-1717-6

Keywords

  • Breast cancer
  • Quality
  • SEER-Medicare
  • Adjuvant chemotherapy
  • Timing
  • Hormone receptor negative